Clozapine use presenting with pseudopheochromocytoma in a schizophrenic patient: a case report.

Introduction. There have been six previous cases that reported pseudopheochromocytoma in patients taking clozapine. Our case showed the direct link of clozapine to serum levels of certain markers. Case. This is a case of a 49-year-old obese Caucasian female who was referred to endocrinology for investigation of Cushing's syndrome, based on raised blood pressure and Cushingoid facies. The patient had underlying schizophrenia and was stable on clozapine. Her blood pressure was 150/99 mmHg on bendroflumethiazide and candesartan. We measured her 24-hour urinary-free cortisol, which was normal but 24-hour urinary-free noradrenaline was elevated at 835 nmol (76-561) with normal adrenaline 36 nmol (7-82) and dopamine 2679 nmol (366-2879), as the patient had history of palpitations and sweating. Two sets of 24-hour urinary-free cortisol measurements were normal and serum cortisol suppressed to <50 nmol/l after a 1 mg overnight dexamethasone. Two further 24-hour urinary-free catecholamines showed a raised level of noradrenaline. MRI demonstrated normal adrenals and MIBG scan did not show any abnormal uptake at adrenal glands. Conclusion. Pseudopheochromocytoma has been reported in patients taking clozapine. A number of different mechanisms for raised plasma noradrenaline levels with clozapine have been postulated. The above case highlights an unusual but known side effect of clozapine.

Seasonal variations, speciation and possible sources of mercury in the snowpack of Zhadang glacier, Mt. Nyainqêntanglha, southern Tibetan Plateau.

Ten snowpits were sampled at the Zhadang glacier during 2008 and 2011 to investigate the seasonal variations, speciation, and sources of mercury (Hg) in the southern Tibetan Plateau. In the 2008 snowpit, total Hg (Hg(T)), particulate matter, most of major ions were found in higher concentrations during the non-monsoon season than in the monsoon season. Analysis of Hg speciation indicated that Hg(T) in the 2011 snowpits was dominated by particulate-bound Hg (Hg(P)). Most of particulate matter in the 2008 snowpit was dominated by fine particulates, indicating that the influx of particulate matter and Hg(P) was probably occurring by long-range transportation via general atmospheric circulation. Analysis of dominant ion Ca²âº and alkaline pH values has suggested that the long-range transported Hg(P), originating from dust storm activities, may be the most important source for Hg in the Zhadang glacier snowpit during the non-monsoon season. Backward-trajectory analysis indicates the majority of the air masses arriving at the Zhandang glacier originated from the arid regions of northwestern India (e.g., Thar Desert), confirming that arid regions in central and southern Asia are likely the main sources of Hg being deposited in the Zhadang glacier snowpit. This study also suggests that ice core records from the Tibetan Plateau may be useful tools for interpreting long-term historical records of atmospheric Hg deposition, and reconstructing Hg biogeochemical cycling.